Svensson Per, de Faire Ulf, Niklasson Urban, Hansson Lars-Olof, Ostergren Jan
Department of Medecine, Division of Emergency Medecine, Karolinska Institute Stockholm, Sweden.
Blood Press. 2005;14(2):99-106. doi: 10.1080/08037050510008931.
Increased levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP) are associated with left ventricular dysfunction (LVD) and left ventricular hypertrophy (LVH), but the relation of NT-proBNP to ambulatory blood pressure (ABP) and hypertensive target organ damage in high-risk patients with peripheral arterial disease (PAD) has not been studied. We hypothesized that NT-proBNP levels were increased in patients with PAD in comparison to a matched control group and that levels of NT-proBNP were related to ABP.
Blood samples were analysed for NT-proBNP in 103 males with PAD and 96 age- and sex-matched controls. Ninety-eight PAD patients performed ABP monitoring and 99 underwent Tc-99m Sestamibi myocardial perfusion SPECT.
NT-proBNP was significantly increased in PAD patients compared with controls [median (interquartiles)] 167(76, 418) vs 68(38, 142) pg/ml, p<0.001. Plasma levels of NT-proBNP correlated positively to systolic blood pressure (SBP), pulse pressure (PP), night-day ratio of SBP and showed the strongest correlation to average night PP (r=0.42, p<0.001). In multiple regression analysis, night PP remained independently related to NT-proBNP.
NT-proBNP levels are markedly increased in PAD patients compared to age-matched controls. Night PP is related to NT-proBNP levels independently of other variables highlighting the importance of ambulatory PP as a cardiovascular risk factor. Measurement of NT-proBNP could be indicated in PAD patients for further risk stratification.
N 末端脑钠肽前体（NT-proBNP）水平升高与左心室功能障碍（LVD）和左心室肥厚（LVH）相关，但 NT-proBNP 与外周动脉疾病（PAD）高危患者的动态血压（ABP）及高血压靶器官损害之间的关系尚未得到研究。我们推测，与匹配的对照组相比，PAD 患者的 NT-proBNP 水平升高，且 NT-proBNP 水平与 ABP 相关。
对 103 例患有 PAD 的男性患者和 96 例年龄及性别匹配的对照者的血液样本进行 NT-proBNP 分析。98 例 PAD 患者进行了 ABP 监测，99 例接受了锝-99m 甲氧基异丁基异腈心肌灌注单光子发射计算机断层扫描（Tc-99m Sestamibi 心肌灌注 SPECT）。
与对照组相比，PAD 患者的 NT-proBNP 显著升高[中位数（四分位间距）]167（76，418）pg/ml 对 68（38，142）pg/ml，p<0.001。NT-proBNP 的血浆水平与收缩压（SBP）、脉压（PP）、SBP 的昼夜比呈正相关，且与平均夜间 PP 的相关性最强（r=0.42，p<0.001）。在多元回归分析中，夜间 PP 仍然独立于 NT-proBNP 相关。
与年龄匹配的对照组相比，PAD 患者的 NT-proBNP 水平显著升高。夜间 PP 与 NT-proBNP 水平相关，独立于其他变量，突出了动态 PP 作为心血管危险因素的重要性。在 PAD 患者中测量 NT-proBNP 可能有助于进一步进行风险分层。
